HomeMy Public PortalAbout4815ALESSANDRO AVE_Plumbing (3) 76A667.k(CE 8175) 11/76 / a
APPLICATION FOR PLUMBING PERMIT
eC u EX lei Qe5 111178
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
WATER CLOSET LOCALITY
NEAREST
BATH TUB — CROSS ST
1 SHOWER 3 a OWNER
LAVATORY Z _ MAIL
J ADDRESS
SINK CITYTEL NO
DISHWASHER CONTRACTOR IFT
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL NO 4:?i
LAWN SPRINKLER SYSTEM STATE LIC
WATER HEATER LICENSE NO i 7-.a(Q CLASSel
GAS SYSTEM OUTLETS DISTRICT NO G PONE I VROCESSED BY
OUTLETS OVER lP
5 PER SYSTEM INDUSTRIAL
WASTE APPROVAL U
INSPECTION RECORD u
b. id
to
z
Plan check fee
PLUMBING PERMIT ISSUING FEE$ ¢ ��
TOTAL FEE �j S 0
Plan check applicant
APPROVALS DATE INSPESTOR S SIGNATURE
Name
UNDER SLAB WORK
Address ROUGH PLUMBING fs�9
City Tel No GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES HOT WATER HEATER
AND STATE LAWS REGULATING PLUMBING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY UTILITY CO NOTIFIED
L
ATUREATRMITTEE F Al
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION cK M o CASH
" 2 Or"--HAY 31 5 0> 1 6.5 0 ,&5o
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